Preparing for
treatment

Having a stem cell transplant is very physically demanding. Your healthcare team will tell you what to expect, and how to prepare for it.

You will have tests and scans before the transplant to check your general health, including how well your lungs, heart and kidneys work. You may also have a central line, inserted into a vein in your chest. Blood samples can be taken and medicines given through this line.

You will know the date of your treatment in advance. This means you can start to make practical arrangements, such as letting your work know, organising pet or child-care, or making sure your house will be secure while you’re in hospital.

You can usually arrange to visit the unit beforehand and meet the team who will be looking after you. They can tell you what things you might want to bring with you for your stay in the unit. They can also give you information for your visitors.

Reviewed: 31 Jul 2014 Next review: 2016

Getting ready for treatment

Having a stem cell transplant is very physically demanding. It’s important to make sure that you’re fit enough to have the treatment. The doctors need to know whether you have any medical conditions that could cause complications afterwards, so they will ask you some questions about your health before treatment begins.

If you smoke, you’ll be advised to stop, as it increases your risk of complications and long-term side effects. Your GP can give you advice on stopping smoking.

Tests

You’ll have a number of tests before the treatment. Your doctor or specialist nurse will explain what they are and why they are needed. They may include:

blood tests to check your general health and whether you have any infections (including hepatitis B and C, and HIV)

a chest x-ray to check your lungs and heart

tests to check how well your lungs work

tests to check how well your kidneys work

tests to check that your heart is healthy, such as an ECG (electrocardiogram), an echocardiogram or a MUGA (multiple gated acquisition) scan

a dental check to make sure you don’t have any problems that might cause an infection

a computerised tomography (CT) scan

a bone marrow biopsy or lumbar puncture to check whether there is any disease in the bone marrow or spinal fluid.

The tests you have will depend on the type of cancer or leukaemia you have.

Central line

While you’re in hospital, you will have regular medicine into your veins (intravenously) and will have several blood tests. To make this easier, a soft, plastic tube (central line) can be put into a vein in your chest. Your doctor will arrange for you to have a central line before your treatment starts.

Central lines can be used to:

give drugs, fluids, blood and platelets

give the stem cells

collect blood samples.

The type of central line most commonly used for high-dose treatment is called a skin-tunnelled central venous catheter. Different brands are available, including Hickman® or Groshong®, and you may hear them being called these names.

A central line is usually put in under a local anaesthetic. The doctor or nurse makes a small cut (incision) in the skin on your chest. They thread the line under your skin and into a large vein in your chest. It may feel sore or uncomfortable for a couple of days after the line has been put in. Regular painkillers will help.

The central line has a small cuff that can be felt under the skin just above where the line goes in. The tissue under the skin grows around this cuff and holds the line safely in place. Until this happens, you will have a stitch to hold the line in place. This stitch is usually taken out after three weeks.

When the line is in place, you will see a thin flexible tube coming out from your chest. This tube may divide into two or three tubes, called lumens. This allows different treatments to be given at the same time. Each lumen will have a cap on the end that syringes or drips can be connected to.

Other types of central line include:

A PICC (peripherally inserted central catheter) line – This is a thin, flexible tube that is put into a vein in the bend or upper part of the arm. It is threaded through the vein until the end of it lies in a vein near the heart. The other end of the tube stays outside your body and has a screw cap at the end. Drips or syringes can be attached to it.

An implantable port – This is a thin, soft, plastic tube that is put into a vein in the chest and has an opening (port) just under the skin on your chest.

Fertility

In most cases, conditioning treatment stops women’s periods and stops men from producing sperm. Your specialist will be able to tell you how the treatment is likely to affect your fertility. It’s important to talk to your cancer specialist about this before treatment starts. There may be ways of preserving your fertility, so that you may be able to have children in the future. If you have a partner, you may want them to be with you when you talk to your specialist, so you can discuss any fears or worries together.

Men

You can usually store sperm before your treatment starts. It can be used later with fertility treatment, when you’re ready to have a family. Storing sperm for use in the future is also important for teenage boys.

Women

It may be possible to store fertilised eggs (embryos), which can be used in the future when you’re ready to try to get pregnant. If you don’t have a partner, it may be possible to store unfertilised eggs. Another way of preserving women’s fertility is to remove and freeze tissue from an ovary that contains eggs. This is a new and experimental technique and may not be available everywhere.

Support

Fertility is a very important part of many people’s lives. Not being able to have children can seem especially hard when you already have to cope with cancer. Some people may find it helpful to talk about their feelings with a trained counsellor. If you need more specialised help, your doctor can arrange this for you.

Visiting the unit

Before you have treatment, you can usually visit the unit. It’s a good idea to take a relative or friend with you. During the visit, you may meet and talk to members of the team who will be looking after you. They’ll tell you what to expect and advise you on how to prepare for your treatment. The team may include:

one or more haematologists who specialise in diagnosing and treating blood disorders and blood cancers

an oncologist (cancer specialist) who specialises in treating your type of cancer and giving radiotherapy

a transplant coordinator (specially trained nurse) who gives information and support during the treatment and may also arrange some of the tests you need before and after treatment

nurses who specialise in the type of cancer you have and give information and support

nursing staff who may give you some of the treatment (such as chemotherapy) and carry out day-to-day care.

The team may also include other healthcare staff, such as social workers, dietitians, pharmacists, psychologists, counsellors and physiotherapists.

The nurses may show you around the unit and the type of room you will be in during your stay, although this may not always be possible. They can tell you what things you might want to bring with you for your stay in the unit.

Getting organised

Once you understand what the treatment involves, you can take time to think things over and start to make practical arrangements.

You will know in advance the date you go into hospital to start your treatment. This will help you to plan. As you are going to be in hospital for a few weeks, you might have a few things to do, which may include:

Going into hospital

What to take with you

The nurses will give you ideas about what to bring with you to help pass the time and make you more comfortable. This can vary between units. It’s a good idea to take some books, magazines, music or audiobooks. You may also be able to bring films or computer games. Many hospitals have radios, TVs and DVD players. The nurses will tell you what’s provided.

As you will be staying in your room for a few weeks, you may want to bring items from home to make you feel more comfortable. You might like to have personal things with you such as photographs, pictures or possibly a special blanket or pillow that has been cleaned.

You will also need to bring comfortable, loose-fitting clothes.

Soft, cotton materials are best, and tops with buttons will make it easier when you’re being examined. Ask the nurses for advice on the kind of toiletries you should bring with you.

Teenagers and young adults

Some hospitals have specially designed teenage and young adult cancer units (sometimes called TYA units). There may be computer games, DVDs and music to help you feel more at home. You may have access to a computer so that you can do some of your school or college work if you feel well enough. There may also be education specialists who can stay in touch with your school or college and support your learning needs while you’re having treatment.

Visitors

Visitors, especially close family and friends, are important.

They give you support and help you keep in touch with life outside hospital. Some units have rooms where family members can stay overnight. This is useful if your relatives have to travel to hospital.

Most hospitals are flexible about visiting, but different hospitals have different rules. You may be restricted to a certain number of visitors each day to help protect you from infection. The nurses will explain more about this to you.

Questions you might want to ask

How many visitors can I have and how long can they stay?

Is there anyone who shouldn’t visit, such as children?

What precautions will visitors have to take when they come to see me?

Can I bring my mobile phone? Is there a phone I can use, and will I need coins or a phone card?

Can I bring a laptop or mobile computer (tablet), and will I have access to the internet?

Do I need to follow a special diet? Are there any foods that I should avoid?

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